The range for this role is $25 - $34.13
Actual base pay will be determined based on a successful candidate's work location, skills/abilities, experience, and education.
Interested applicants must be willing and able to work onsite minimum 4 times per week in either our Melbourne, FL or Orlando, FL office.
The Mission
At Christian Care Ministry we believe that Christians can, and should, share in one another’s burdens. Through the use of Medi-Share®, a healthcare sharing ministry for Christians, we cultivate that belief. To that end, our Mission Statement is as follows: Connecting people to a Christ-centered community wellness experience based on faith, prayer, and personal responsibility.
The Team
Everyone at Christian Care Ministry is in agreement with our Statement of Faith, which outlines our core beliefs. Although we aren’t perfect people, we are serving our perfect God and our Members to the best of our ability.
The Job
The Appeals Nurse (LPN) is responsible for supporting the Appeals/Grievances function by explaining the membership voted guidelines and utilizing your medical knowledge to guide members through the appeals process. The LPN will also complete tasks for gathering and obtaining all needed information for the appeal such as medical records, provider letters, etc. The responsibility of the Appeals Nurse (LPN) is to work collaboratively with members of the team to provide the needed support in communicating with members and providers to obtain needed information and explain the appeal process and status.
Essential Job Duties & Responsibilities
- Answer member questions about medical records, how they apply to their bills, and the appeal process
- Communicate with members and/or providers what is needed for case review preparation and delivery of determination status
- Organize and ensure we have all needed medical records, lab results, and radiological reports, etc.
- Learn and maintain an understanding of Medi-share program guidelines and appeals processing functions
- Acquire medical records for appeals from providers
- Keep members informed of the appeal process and pray with them
- Coordinate the next steps in the appeal process when necessary
- Set up the next level of appeals for members
- Be a point of contact for member while in appeals process
- Maintain workflow follow up in various queues
- Document medical correspondence received from members and providers following approved processes
- Receive inbound and place outbound calls from/to members and providers
- Help to maximize cost savings by referring cases to other departments, as needed
- Assist with overflow from Appeals Admin; such as obtaining medical records, help with conclusion letters, contacting members or help any way with overflow and coverage
- Work autonomously to prioritize and manage workload
- Comply with all organizational HIPAA requirements
- Contribute to the exercise and expression of Christian Care Ministry’s Christian beliefs
- All other duties as assigned
Essential Skills & Abilities
- Understand diversity of systems and workflows as they relate to the type of review or assignment
- Ability to multitask in multiple operating systems
- Ability to work for extended periods of time on the computer
- Ability to be objective and impartial
- Ability to de-escalate difficult conversations
- Ability to communicate effectively with both internal and external customers
- Possess ability to adapt to changing processes
- Working knowledge and application of program guidelines
- Ability to practice good interpersonal skills and work as a member of a team
- Ability to work autonomously to prioritize and manage workload
- Knowledge in the use of the internet including e-mail and search engines
- Word processing and keyboard skills of at least 25 wpm
- Basic knowledge in Microsoft Office (Excel, Word, Outlook)
- Ability to use a database system, including how to update fields
- Knowledge of a document imaging system
Core Competencies/Demonstrable Behaviors
- Drives Results – consistently achieves review results, even under tough circumstances and tight deadlines
- Courage – ability to supply objective conclusions based on review regardless of risk or potential criticism
- Initiative – identifying what needs to be done with a willingness to take action
- Member First – exhibits full commitment to serving members and/or clients by prioritizing their needs first in alignment with our program’s purpose. This commitment is demonstrated through understanding of the program(s), provided through quality and timely service while exercising empathy in every interaction. Every CCM employee shares responsibility to steward resources faithfully, removing barriers to understanding, and creating accessible, connected, and Christ-centered experiences.
- Humble – demonstrates Christ-Centered humility by honoring others, accepting feedback, and prioritizing collective success over individual recognition
- Hungry – exhibits initiative, perseverance, and commitment to serving God through excellence. Demonstrates passion for personal and organizational growth while diligently advancing the mission of Christian Care Ministry
- Smart – shows relational and emotional intelligence, communicates effectively, collaborates harmoniously, and reads social cues with grace and discernment
Education and/or Experience
- LPN license required with sound knowledge of anatomy and physiology and disease processes required
- Experience in medical record clinical reviews or appeal/grievances within a healthcare payer organization preferred
Supervisory Responsibilities
- This job has no supervisory responsibilities
Incentives & Benefits
We work hard to serve our Medi-Share Members, but know we can only do that if we invest in our employees professionally, financially, physically, socially, and spiritually. We purposefully invest in our employees so that our employees can invest in others.
For full-time employees working 30 hours or more, some of our benefits include, but are not limited to:
- 100% paid Medical for employees/99% for family
- Generous employer Health Savings Account (HSA) contributions
- Employer-paid Life Insurance (3x salary) and Long-term Disability Insurance
- 6 weeks of paid parental leave (for both mom and dad)
- Dental - two plans to choose from
- Vision
- Short-term Disability
- Accident, Critical Illness, Hospital Indemnity
- 401(k) – up to 4% match on ROTH or Traditional contributions
- Generous paid-time off and 11 paid holidays
- Wellness plan including Financial, Occupational, Mental/Spiritual, and Physical health incentives up to $50/mo
- Employee Assistance Program including no cost, in-person mental health visits and employee discounts
- Monetary Anniversary Awards Program
- Monetary Birthday Awards
Minimum Age Requirement: Due to the nature of the responsibilities associated with this position—including independent decision-making, access to confidential information, and potential exposure to regulated environments—candidates must be at least 18 years of age at the time of hire. This requirement is in accordance with applicable federal and state labor laws and is intended to ensure compliance with workplace safety and legal standards.